healthcare
mikethemadbiologist | March 2, 2007There's a very interesting Boston Globe story about Paul Levy, the CEO of Boston's Beth-Israel Deaconess Hospital. He's not only a CEO, but also a blogger. His blog, Running a Hospital, is, well, self-explanatory--I guess you can blog about work...if you're the boss. Levy appears to have started a minor kerfuffle because he has been posting his hospital's catheter-associated ICU infection rates.
Some of the other hospital heads are bothered that Levy is doing this. Personally, I think patients should be informed about infection rates when choosing a hospital, since hospital-acquired…
mikethemadbiologist | February 12, 2007Here's some very good news about MRSA (methicillin resistant Staphylococcus aureus): U.S. hospitals are beginning to implement their own versions of 'search and destroy' (italics mine):
Hospitals can stem the alarming spread of a dangerous and drug-resistant staph infection by screening new patients and keeping them quarantined, say doctors who tried this novel approach.
One model is a pilot program started in 2001 at the Pittsburgh Veterans Affairs Healthcare System, which has dramatically cut the rate of the potentially deadly germ, called methicillin-resistant Staphylococcus aureus, or…
mikethemadbiologist | February 9, 2007I'm at a meeting in D.C. about antibiotic resistance, so I've left the Blogerator 9000 to fire up this post from the archives about a drug company executive's explanation of how drugs are priced. It's remarkable--and frustrating--that nobody has picked up on the basic message: drug prices are consumer driven, not R&D expenditure driven.
This is a headline from the June 1st, 2005 edition of ScripNews (subscription only; so I'm a little behind in my reading-what scientist isn't?). Here's the punchline for lazy stupids that don't like to read: the head of Pfizer has admitted that the cost…
mikethemadbiologist | February 3, 2007It should tell you just how loony the Christopath right is when a conservative Texas governor gains admission to the Coalition of the Sane (for the time being, anyway). How did Texas governor Rick Perry do it? By mandating that schoolgirls receive the HPV vaccine, and that the state subsidize the vaccinations. From the AP:
Some conservatives and parents' rights groups worry that requiring girls to get vaccinated against the sexually transmitted virus that causes cervical cancer would condone premarital sex and interfere with the way they raise their children.
By using an executive order…
mikethemadbiologist | January 27, 2007Because a good healthcare system isn't like the Manhattan Project or putting a man on the moon. When you read articles, blog posts, and books about trying to change the healthcare system, often an argument is made about how difficult finding a solution is.
Well, I call bullshit. We're not trying to develop the first nuclear reactor, or figure out how to actually land on the moon. All of the original NATO allies, some of the newer ones, and the non-aligned European countries are able to provide at least basic, and in most cases, good healthcare to their citizens. All of these countries are…
mikethemadbiologist | January 24, 2007No, I'm not referring to Bush's State of the Union, but Senator James Webb's response. What's interesting is how hard he hit the economics:
There are two areas where our respective parties have largely stood in contradiction, and I want to take a few minutes to address them tonight. The first relates to how we see the health of our economy - how we measure it, and how we ensure that its benefits are properly shared among all Americans....
When one looks at the health of our economy, it's almost as if we are living in two different countries. Some say that things have never been better. The…
mikethemadbiologist | January 23, 2007Let's just say, for sake of argument, that Bush's proposed tax plan for healthcare would actually lower premiums. There's something rather obvious that his plan seems to miss.
If insurers make less money through premiums, they will find other ways to recoup their diminished income.
How would they do this? Here are three ways, all of which are happening now, so they can't be viewed as far-fetched:
1) People with pre-existing conditions won't be accepted by private plans.
2) More and more procedures will be defined as 'non-essential', so they will not be covered (note: this also includes…
mikethemadbiologist | January 13, 2007The most common hospital-acquired infections in intensive care units are ventilator-associated pneumonias ('VAP'), which have mortality rates between 20-50 percent. The more quickly the appropriate antibiotic can be given to the patient, the more likely the patient is to survive. Researchers in Spain have developed a rapid technique for determining which antibiotic (or antibiotics) to use.
First, a very brief bit about VAP. These infections usually result from intubation--a tube is inserted into the the mouth, through the larynx, and into the trachea, and is hooked up to a ventilator (…
mikethemadbiologist | January 11, 2007Massachusetts is trying to tackle the problem of hospital-acquired ('nosocomial') infections by adding $1 million dollars in funding to track and monitor hospital compliance with infection control measures. As I've discussed before, nosocomial infections are a huge problem, and may account for roughly a quarter of all hospital costs. From the Boston Globe:
State officials plan to increase scrutiny of hospital-acquired infections in Massachusetts as a way to significantly lower their frequency, and they hope to require all hospitals to report their infection rates to the state by next year.…
mikethemadbiologist | December 31, 2006Finally, there might be a Democrat who speaks my language about deficits and budgets. From Tapped (italics and bold mine):
I think the honest answer to this question is that there's a tension between our desire to eliminate the deficit and create a stronger economic foundation and eliminate some of the debt our children will inherit, there's a tension between that deficit and our need to invest and make America stronger for the 21st century.
I think that, if we're honest, you cannot it, it's just common sense in the math, have universal health care, and invest in energy, and make a serious…
mikethemadbiologist | December 23, 2006At a recent conference (pdf), Dr. Rebecca Roberts described how medical residents and doctors treat urinary tract infections. But first, a bit about 'empirical therapy.'
When a patient is sick it can take anywhere from 24-72 hours at a hospital with good facilities to identify what organism is causing the disease and which antibiotics will be effective against it. Empirical therapy uses the patterns of resistance (and infections) of previous cases at the hospital in conjunction with other guidelines to choose the most effective antibiotic therapy. Think of it as a highly educated guess--…
mikethemadbiologist | December 22, 2006At a recent conference I attended (pdf file), one speaker (Dominique Monnet) presented a very interesting observation about the relationship between the number of different antibiotics available and the amount of antibiotics prescribed.
Quite simply, as the number of potential competiting drugs increases, the amount of drugs prescribed increases:
(from here; the y-axis is the number of daily doses per 1000 residents)
There are at least two reasons for this pattern:
1) Advertising aimed at doctors and hospitals is more likely to increase use simply because doctors will be influenced to use…
mikethemadbiologist | December 20, 2006At a recent conference (pdf), I heard Dr. Rebecca Roberts describe the economic cost of antibiotic resistant infections at Cook County's Stroger Hospital. In a nutshell, it's terrifying.
The average cost per patient at that hospital is $10,000. The cost of treating an antibiotic resistant infection excluding acute respiratory infections ('ARI')--this does not include the average cost of antibiotic sensitive infections--is $1,934. That is, of the $10,000 average cost, $1,934 goes to 'subsidize' the cost of antibiotic resistant infections. The $1,934 figure is the low estimate: the average…
mikethemadbiologist | December 5, 2006In Las Vegas, the SEIU nurses were recently locked out during contract negotiations (they're back to work now). The nurses don't want pay increases or better benefits, but a lower patient-to-nurse ratio. Universal Health Services, the for-profit hospital chain, claims the nurses are trying to expand the union membership. The nurses claim that they simply want to improve patient care. Regardless of the motives involved, there is one indisputable fact: having fewer patients per nurse decreases the likelihood that a patient will become infected while in the hospital.
I've blogged about…
mikethemadbiologist | December 1, 2006One of the constant refrains I always hear is that diarrheal diseases, such as shigellosis, cholera, and other bacterial dysenteries, could be easily solved if there were adequate potable water and sanitation. That's completely correct. It's also completely unrealistic, as a recent editorial by Lorenz von Seidlein in Tropical Medicine & International Health argues.
The problem is that this 'ultimate' solution of massive infrastructure investment often means that foreign governments and NGOs are discouraged from effective, short-term solutions. One such solution is the oral cholera…
mikethemadbiologist | November 18, 2006
(from here)
Because if janitors get healthcare, then the terrorists win
Last night, Houston police used horses to break up a peaceful demonstration by unionized janitors, who on average, make $5.35/hr and have no health care. You know, if the Houston police were civilized they would have tasered them. One janitor described the scene thusly:
The horses came all of a sudden. They started jumping on top of people. I heard the women screaming. A horse stomped on top of me. I fell to the ground and hurt my arm. The horses just kept coming at us. I was terrified. I never thought the police would…
purepedantry | November 14, 2006We're mad as hell, and we are not going to take it anymore:
In recent years, women's health has been a national priority. Pink ribbons warn of breast cancer. Pins shaped like red dresses raise awareness about heart disease. Offices of women's health have sprung up at every level of government to offer information and free screenings, and one of the largest government studies on hormones and diet in aging focused entirely on older women.
Yet statistics show that men are more likely than women to suffer an early death.
Now some advocates and medical scientists are beginning to ask a question…
mikethemadbiologist | November 5, 2006There is absolutely nothing the Republicans won't politicize. Now, they have launched the War on Vaccination. For a decade, the Robert Wood Johnson Foundation, a foundation dedicated to improving public health, particularly among the poor and the elderly, has funded a "Vote and Vax" program at early voting facilities that serve poor neighborhoods in 24 cities. Basically, if you're over 50, you can get a vaccination at the polling location.
Thursday, in Houston, the Republicans filed a lawsuit to stop this program.
Nevermind that the program has been running for ten years. When the program…
mikethemadbiologist | October 26, 2006I have discussed the "search and destroy" strategy for controlling and reducing methicillin resistant Staphylococcus aureus (MRSA) before. Search-and-destroy involves the screening of every patient and hospital worker for MRSA.
Patients with MRSA are isolated to prevent spread to other patients. In the Netherlands, hospital workers with MRSA are sent home with pay, and are treated with muriopicin nasal drops (MRSA usually lives up your nose). In addition, the workers' family is screened along with any pets, and those that have MRSA are also treated. Because of this program, the…
mikethemadbiologist | September 25, 2006Do you want to know how to stop, or at least, lessen the next E. coli 0157:H7 outbreak? Improve our surveillance and public health infrastructure.
If we improve the infrastructure, we can speed the response time, making it easier to contain an outbreak.
Let's walk through each of the steps the CDC outlined in its response.
1. Incubation time: The time from eating the contaminated food to the beginning of symptoms. For E. coli O157, this is typically 3-4 days.
There's not much we can do to 'improve' this step. While random testing could be an option, when it comes to produce, I don't see…